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rCWARD ' � NON-HAZARDOUS WASTE MANIFEST <br /> CORPORATED WASTE TREATMENT AND DISPOSAL FACILITY i <br /> -' JCB ACCEPTANCE N0. <br /> ENERATOR ° ^ , �� i <br /> ��„�., I -. Y M ; ,s REQUIRED PEpSONAL PROTECTIVE EQUIPMENT <br /> r0-:), <br /> �� aQLOVES [_-]GOGGLES ❑RESPIRATOR HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> iY SPECIAL HANDLING PROCEDURES <br /> C1TY,ST,$TE,ZIP, ,,, <br /> PHONE <br /> ' _ � , <br /> CON�CTERSN - <br /> SIGNATUR15 OFTHORIZELI-AGENT,?,�L,! <br /> WASTE TYPEr =, a_ :f"a ';� �`s - t�f�rz RECEIVING FACT <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL I <br /> • Q DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY - - (209) 982-4298 PHONE <br /> t_~y -`-'� ) �r �� � � (209) 982- 1009 FAX <br /> ,r V A � <br /> NAME rw TRUCK NUAABER <br /> _ IU 7 g Of <br /> . CITY,'STATE,hZIP ,� <br /> • PHONE'�, ` SEND DUMP-- BOTTOM©UMP TRANSFER <br /> 51GNAT OFAUTH iZED AGENT OR I R�VE�R - DA7If'j'z��� :� bLL�Q�}�� ��u, BE©, VAN DRUMS <br /> CUBIC�YARDS�k��;R�" ,r - <br /> FORWARD INC, LANDFILL <br /> Forward shall have no obligation to accept the waste if weather or other F <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD r``-!_{TO BE COMPLETED BY FORWARD) # <br /> impairs the safe and effective operation of the Landfill Forward shall use <br /> reasonable efforts to promptly notify Disposer of its inability to accept the =" «r DISF PSE"sk BIO ky AERATE STOCKPILE OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on Q SOIL l <br /> weather or other site conditions Forward shall notify the Disposer when site <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> ` MARK$ ._ _-._,. � -�-�-- - ��. — -�.*.,. _T�.•, <br /> RE ^r '< ❑ NON-FRIABLE f <br /> FACILITY TICKET NUMBERASBESTOS 9 <br /> ❑ WOOD <br /> SIGNATURE OFsAUTHORIZED AGEN "; ,p ' r QATE <br /> ��j ---- f ❑ ASH <br /> -�'f�` - f f ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4 QO P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209)962-4298 I <br /> MANIFEST # s o o 19 <br /> Sa4i36+10P'Y <br /> _ I <br />